Insurance indemnity and medico-legal support

We know doctors work hard to deliver good quality healthcare. But sometimes, things go wrong. If a patient has suffered harm as a result of a doctor’s negligence, it’s important that doctors have adequate and appropriate insurance or indemnity to compensate the patient. Insurance and indemnity will also provide you with access to personal regulatory and medico-legal support and advice if you ever need it. 

Please see the section on medico-legal advice and assistance 

This guide gives help to doctors, patients, employers and responsible officers / suitable persons, in understanding what insurance and indemnity means for them.

I’m a doctor, what does this mean for me?

You must make sure that you have adequate and appropriate insurance or indemnity arrangements in place covering the full scope of your medical practice in the UK. The cover you need is very much dependent on your circumstances and must be in place by the time you begin to practise.For advice on the cover you need, speak to a medical defence organisation or another professional insurance or indemnity provider. Your employer or the organisation you are contracted to work for may also be able to help. We give some examples of the type of cover you may need below.When you’re asked about your insurance and indemnity by a patient or someone you’re connected with professionally (your employer, responsible officer / suitable person or designated body for example), you should be able to confirm that you hold adequate and appropriate cover in line with the requirements of Good medical practice We don’t hold a record of your insurance and indemnity details.

Insurance and indemnity when you work for an NHS trust or board, or Health and Social Care (HSC) Trust (in Northern Ireland)

If you work for an NHS or HSC body, the organisation you work for will receive indemnity through a clinical negligence scheme.

This applies even if you are a locum for an NHS or HSC body.
You should also consider whether you need to take out additional professional insurance or indemnity for work that is not covered by NHS or HSC body indemnity and to access personal regulatory and medico-legal support and advice. 
If you are treating NHS patients privately, you must check with your NHS or HSC body employer what indemnity is in place.

Insurance and indemnity when you’re carrying out private or independent practice 

If you carry out any private or independent practice, you must arrange adequate and appropriate insurance or indemnity (even if this work takes place on NHS or HSC body premises). This applies even if the work is in addition to work you do for an NHS or HSC body. 

Many independent healthcare providers will ask you for confirmation of your insurance or indemnity arrangements as part of their pre-employment checks. Some independent healthcare providers provide insurance and indemnity for the work you do for them but you should always check that it gives you adequate cover for all of your work.

If you’re doing private work in the UK and hold (or plan to hold) an EU wide insurance policy arranged outside the UK, you must: 

  • check with your provider to ascertain whether or not when the UK leaves the EU that your EU insurance or indemnity will continue to be valid to cover your work in the UK, and
  • make sure that your EU insurance or indemnity is adequate and appropriate, and of sufficient value (at least the same value as a UK policy of insurance or with the same scope as a UK indemnity arrangement) to cover any claims made about your practice in the UK through the UK legal system.

Insurance and indemnity when you’re working as a GP in England 

If you work in England as a GP, trainee GP or locum under a medical services contract (GMS, PMS or APMS) you will receive indemnity (for claims arising from incidents which took place on or after 1 April 2019) through the Clinical Negligence Scheme for GPs (CNSGP), which is administered by NHS Resolution. More information about the scheme is available on the NHS Resolution website

You will need to maintain membership with an MDO or other indemnity provider or insurer to retain cover in respect of activities and services not covered by CNSGP or GMPI – including non-NHS or private work, inquests, regulatory and disciplinary proceedings, employment and contractual disputes, and non-clinical liabilities. 

 

You must also have appropriate arrangements to cover you for liabilities that arise from your practice as a doctor whenever a claim is brought (such as ‘run off’ cover).

It is important that you assure yourself that you have appropriate arrangements in place for all aspects of your clinical practice. If you are unsure about your current indemnity arrangements then you should contact your existing indemnity provider or insurer to check and potentially retain or arrange additional cover if necessary. 

The DHSC has published a statement explaining this.

Please see the section on medico-legal assistance and advice

Insurance and indemnity when you’re working as a GP in Wales 

If you work as a GP in Wales you will receive indemnity (for claims arising from incidents which took place on or after 1 April 2019) through a General Medical Practice Indemnity (GMPI) scheme managed by the Legal and Risk Services team at the NHS Wales Shared Services Partnership (NWSSP).  More information can be found on NWSSP’s website and in these guidelines and FAQs

If you are working as a locum GP in Wales, you will need to join the All Wales Locum Register. The Employment Services Division of NWSSP can advise on the application process. The Welsh government has published a statement explaining this

You will need to maintain membership with an MDO or other indemnity provider or insurer to retain cover in respect of activities and services not covered by CNSGP or GMPI – including non-NHS or private work, inquests, regulatory and disciplinary proceedings, employment and contractual disputes, and non-clinical liabilities. 

You must also have appropriate arrangements to cover you for liabilities that arise from your practice as a doctor whenever a claim is brought (such as ‘run off’ cover).

It is important that you assure yourself that you have appropriate arrangements in place for all aspects of your clinical practice. If you are unsure about your current indemnity arrangements then you should contact your existing indemnity provider or insurer to check and potentially retain or arrange additional cover if necessary. 

Insurance and indemnity when you’re working as a GP in Scotland or Northern Ireland

The 2018 General Medical Services Contract in Scotland sets out how the Scottish Government will work with partners, including medical defence organisations, to deliver the best solution for indemnity in Scotland. Consideration is being given to the indemnity needs of partners, locums and sessional GPs in the NHS.

However, unless similar schemes are introduced in Scotland, or Northern Ireland, if you are working as a GP in these countries you must arrange adequate and appropriate insurance or indemnity as you will not be covered by the CNSGP. 

 

Working as a private or independent GP

If you carry out any private or independent GP practice in any part of the UK, this work will not be covered by the CNSGP. You must arrange adequate and appropriate insurance or indemnity. 

I’m a locum

As a locum you should check any contract or arrangement that you enter into to make sure you have adequate and appropriate insurance or indemnity in place.

If you’re working as a locum for an NHS or HSC body, indemnity for the organisation will be provided by a clinical negligence scheme.

If you’re working as a locum GP in England you will be covered by the CNSGP for claims arising from incidents which took place on or after 1 April 2019.

If you are working as a locum GP in Wales, you will need to join the All Wales Locum Register. The Employment Services Division of NWSSP can advise on the application process. The Welsh government has published a statement explaining this.

If you are working as a locum GP in Scotland or Northern Ireland you must arrange adequate and appropriate insurance or indemnity as you will not be covered by the CNSGP or GMPI. 

Please see the section on EU wide insurance

Insurance and indemnity for medico-legal work

If you do medico-legal work (like providing advice, writing medical reports, or giving evidence in connection with a legal action, tribunal or hearing) and this work requires you to hold a licence to practise, you must take out adequate and appropriate insurance or indemnity.

What do you mean by adequate and appropriate?

The law says appropriate cover is cover against liabilities that may be incurred in practising as a doctor having regard to the nature and extent of the risks of practising as such. What constitutes adequate and appropriate is a complex area and you need insurance or indemnity that covers the full scope of your practice.

Medical defence organisations and other organisations in the commercial insurance market can advise you about what level of insurance or indemnity is adequate and appropriate for your practice. To get the best possible advice, you must give them accurate and up to date information about the scope and nature of your practice.

When should I review my insurance or indemnity arrangements?

You should do this at regular intervals and whenever your scope of practice, private practice income or employment or contractual arrangements, change.

The terms of your insurance or the scope of your indemnity protection may require you to tell your provider if certain things happen, such as sanctions being imposed on your registration or if you join the Specialist Register.

Please see the section on EU wide insurance

I’ve retired or stopped providing healthcare services – do I still need insurance or indemnity?

Patients who you saw whilst you were working as a doctor should not be left without a way of being compensated after you have retired or stopped working.

You must have appropriate arrangements to cover you for liabilities that arise from your practice as a doctor whenever a claim is brought. 

Providing medical care in emergencies outside work (Good Samaritan acts)

The law only requires you to have insurance or indemnity for medical care you provide as part of your employment or self-employment. A Good Samaritan act (helping someone in an emergency situation) falls outside of this requirement. But you should check with your medical defence organisation, or insurer, to find out whether you have or need insurance or indemnity for any possible liabilities as a result of a Good Samaritan act.

Providing voluntary medical care (good neighbour acts)

Good neighbour acts include helping out, in your professional capacity, at a local sports club or similar planned voluntary work. You’re providing professional medical services whether they are paid or unpaid. If adequate and appropriate insurance or indemnity cover is not given by the organisation for which you are providing this service, you must make your own arrangements to cover yourself.

What is medico-legal advice and assistance – do I need it?

NHS and HSC indemnity schemes only provide indemnity to NHS/HSC bodies for clinical negligence claims. The same applies to indemnity provided by the CNSGP. They won’t give you individual advice and help for other medico-legal matters from your clinical practice, such as criminal or disciplinary investigations.

And they won’t give you individual advice or assistance if we decide to investigate any concerns that are referred to us about your fitness to practise.

You may find it helpful to arrange medico-legal support to cover you in case you’re involved in an inquest where your NHS/HSC body or the CNSGP is unable to support you, or an inquiry or if a complaint is made about you, especially if it is investigated further. 

I’m a patient – what does this mean for me?

Doctors have a duty to confirm that they hold the right level and type of insurance or indemnity cover.

The type of cover that doctors have depends on:

  • where they work
  • whether they are employed or self-employed
  • the type of medicine they practise.

We do not keep a record of doctors’ insurance or indemnity arrangements. If you have a question about a doctor’s insurance or indemnity, you should ask them.

I’m an employer or responsible officer / suitable person. What do I need to know about the insurance or indemnity requirements?

As an employer or responsible officer / suitable person, you’ll probably know that doctors must have adequate and appropriate insurance or indemnity for their practice in the UK. We do not keep a record of the insurance or indemnity arrangements of individual doctors and there may be circumstances that we need to request this information from you.

The type of insurance and indemnity cover a doctor needs to hold depends on their individual circumstances, we’ve set out some examples below. If you are unclear about whether a particular doctor should have insurance or indemnity, you should discuss this with the doctor first.

Please see the section on EU wide insurance

If you’re an NHS or HSC employer

Indemnity for doctors employed by your organisation will be provided by a clinical negligence scheme.

  • In England, indemnity is provided through the Clinical Negligence Scheme for Trusts (CNST), which is administered by NHS Resolution.
  • In Wales, indemnity is provided by Welsh Risk Pool Services.
  • In Scotland, indemnity is provided by the Clinical Negligence and Other Risks Indemnity Scheme, managed by NHS National Services Scotland.
  • In Northern Ireland each HSC Trust assumes the role, funded by the Department of Health.

If doctors in your organisation treat patients on a private basis, you should ensure that they check whether this work is covered or whether they need to arrange their own insurance or indemnity.

If you’re a private healthcare provider

You should check with the doctors you employ or contract, if they will be covered by the organisation’s insurance or indemnity policy or if they need to arrange their own personal insurance or indemnity.

Please see the section on EU wide insurance

If you’re a locum agency

If you place a doctor in a non-NHS or non-HSC post, or as a private or independent GP you should make sure that they have adequate and appropriate insurance or indemnity in place. It may be helpful for you to confirm this information with the organisation that the doctor will be working for. 

Please see the section on EU wide insurance

If you’re a responsible officer or suitable person

As you will be making a recommendation about a doctor’s whole scope of practice, we would strongly advise that you satisfy yourself that the doctors who have a connection with you (for revalidation purposes) have adequate and appropriate insurance or indemnity in place for any medical work they do in the UK. Many responsible officers and suitable persons are doing this through the appraisal process where doctors are required to sign a probity statement that includes reference to ensuring adequate insurance or indemnity is in place.

It is the individual doctor’s responsibility to ensure that they have an adequate and appropriate insurance or indemnity arrangements in place.

We have set out a list of discussion points which you might find useful to gather assurance when you meet with the doctor.

Please see the section on EU wide insurance

The statutory requirement for doctors to have insurance or indemnity

Good medical practice requires doctors to have insurance or indemnity in place where necessary.

We have regulatory powers to check whether doctors have adequate and appropriate insurance or indemnity.

We can:

  • check that any doctor practising in the UK has adequate and appropriate insurance or indemnity cover
  • remove a doctor’s licence to stop them from practising altogether, if we learn that they don’t have adequate and appropriate insurance or indemnity or if they fail to give us the information we ask for 
  • refuse to grant a licence to a doctor if they can’t assure us that they’ll have the adequate and appropriate insurance or indemnity in place by the time they start practising in the UK. 

A doctor must have adequate and appropriate insurance or indemnity in place when they start to practise medicine in the UK. Under the law, a doctor must have cover against liabilities that may be incurred in practising medicine having regard to the nature and extent of the risks. The type and level of insurance or indemnity a doctor requires depends on factors including where a doctor works, whether they are employed (and, if so by whom and for what services) or self-employed, and the nature of work they do.